With Physicians On The Front Lines, Report Recommends Changes For Chronic Pain Treatment
11/15/12 5:50PM By John Dillon
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A new research paper shows doctors in Vermont are feeling the stress of being on the front lines of the fight against prescription drug abuse.
The report lays out several recommendations - including changing insurance policies so that non-drug therapies are covered.
The research effort for the Vermont Medical Society Foundation was led by Dr. Cy Jordan, a former primary care physician. He says he heard time and again in more than 30 interviews that practitioners struggle to treat their patients' chronic pain while also trying to avoid prescription drug abuse.
"The physicians and the dentists and the prescribers find themselves between this rock and a hard place of wanting to offer care and help people - I mean, that's their job - at the same time being scammed and taken advantage of," he says. "So they're very frustrated."
Pain treatment now includes a class of extremely powerful synthetic opiate drugs. The drugs can be legally prescribed but then are sometimes sold on the street. The report includes a startling statement from the state medical examiner that about one Vermonter a week dies from a recreational drug overdose.
"These medications are much more addicting," Jordan says. "There's a bigger downside than was thought in the medical community. And there's a higher awareness of that now."
The report makes several recommendations, both for the medical community and for policy makers in general.
For physicians, the report suggests a single set of guidelines or standards for treating chronic pain.
Dr. Zail Berry is a palliative medicine specialist who also teaches at the University of Vermont College of Medicine. She says the standards would help practitioners who may not have much experience treating pain.
"This is one of things I've been thinking for a long time would be really great, because I'm teaching at the university and trying to convince students and residents to use appropriate principles," she says. "To have something very standardized, that is sort of sanctioned that everybody can feel comfortable about using would be just be a great tool... I don't see the argument against it."
The report also says the state's prescription drug monitoring data base can be improved. The system allows physicians to see if a patient has multiple pain prescriptions from multiple doctors - a warning flag for abuse and doctor shopping.
Physicians reported that the data base is very valuable. Cy Jordan says the system would be even more useful if it was updated more frequently.
"The uploads are only on a weekly basis, and yet out here in the community things happen really fast, particularly when you have people scamming and gaming the system," he says.
The report also takes aim at insurance companies' reimbursement policies. Jordan says insurance carriers will readily cover pain medication, but not treatments involving human touch that are more effective in the long run.
"The way we pay for pain treatment now, it encourages the use of opioids. It does not encourage the use of alternative non-medications, that actually there's more research supporting physical therapy even massage," he says. "There is no research to show that Oxycontin and Percocet work for chronic pain."
Jordan hopes that the Legislature and the Shumlin Administration follow through with policy changes and increased funding for the state's drug monitoring system.